Toronto's homeless are in worse shape than they were 15 years ago, a study released today says. And, in what researchers call a perverse twist, they have less access to health care than ever before.

With soaring rates of diabetes, arthritis and hepatitis C, Toronto's homeless are in worse shape than they were 15 years ago, a study released today says. And, in what researchers call a perverse twist, they have less access to health care than ever before.

According to The Street Health Report 2007, the city's homeless are four times more likely to be refused medical care without a health card – 28 per cent, up from 7 per cent in 1992 – and 59 per cent do not have a family doctor, up from 41 per cent.

Toronto's homeless population has more than tripled since 1992, says the study, which cost roughly $100,000 and surveyed 368 adults with no fixed address. It was conducted jointly by Street Health, a Dundas St. W. clinic that offers health care to the homeless and marginalized, and the Wellesley Institute, a non-profit organization that does research on urban issues.

But not everything has changed since 1992, when the original Street Health Report, the first of its kind in North America, offered a snapshot of life on the streets: 10 per cent of Toronto's homeless still attempt suicide every year; they continue to live on less than $500 a month; and, in the past year, one in three has been beaten and one in five women has been raped.

While the exact number of street dwellers has been difficult to estimate, about 6,500 people slept in shelters last year on any given night, according to the report, compared with a nightly count of 1,900 in the early 1990s.

Brian DuBourdieu, 51, has been on and off the streets for 15 years, but he gave up on shelters long ago. Instead of contending with bedbugs and sleeping with one eye open to protect his possessions – a knapsack carrying a razor, shampoo samples and a packet of instant breakfast mix – he prefers to bundle up and sleep in parks.

Like one-third of Toronto's homeless, DuBourdieu, who has an alcohol addiction, subsists on less than $200 a month, which he earns panhandling.

"I hustle hard," he says. "And I tell good jokes for a quarter."

The study attributes increased homelessness over the past 15 years to funding cuts at the federal and provincial levels and the downloading of services, such as housing, to cities and the province. In the past two decades welfare benefits have dropped to roughly half, after inflation, of what they were in 1995, the study says.

As well, minimum wage and the construction of affordable housing were both frozen in the mid-'90s. One-third of the people surveyed say lack of money for rent is their main reason for being homeless.

Among the study's 13 recommendations:

Increase social assistance rates.

Raise the minimum wage to $10 per hour immediately.

Increase the availability of affordable housing as soon as possible.

"Right now we're not helping people get out of being homeless," Khandor says.

"They're getting stuck in it."

The homeless spend, on average, 4.6 years on waiting lists for subsidized housing, the study says.

DuBourdieu has been on that list eight years. "And I want safe housing," he says. "I don't want to fight people when I'm going into my building."

When it comes to health care, DuBourdieu knows how to get what he needs. While he lost his health card a while ago – 34 per cent of homeless people don't have one, the study says – he visits emergency personnel and his doctor regularly, so they will remember him.

While patients are not supposed to be turned away in an emergency, doctors can refuse to see patients who do not have a health card, researchers say.

Kathy Hardill, outreach nurse and an author of the original study, says the decreased access to health care is one of the study's most shocking findings – especially given the prevalence of disease and disability among Toronto's homeless: Diabetes has increased threefold since 1992; 43 per cent have arthritis, up from 29.8 per cent; and 23 per cent have hepatitis C, which wasn't even surveyed in 1992.

Significant barriers to health care have been erected in the past 15 years, Hardill says, including a clampdown on invalid health cards. Even though the Ministry of Health set up health-card kiosks in 1992 in response to the original study, the homeless often don't have the identification needed to apply, she says.

"People with the highest burden of illness have the least access to care – it's shameful, it's perverse," she says.

"This whole idea of universality of health care in Toronto is nothing but a myth if you're homeless."

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